The factors psychiatrists feel induce and relieve stress in the course of their working lives, as presented in the paper by Rathod et al, ^{Reference Rathod, Mistry, Ibbotson and Kingdon1} are interesting and thought provoking. In our opinion, however, the findings are interpreted idiosyncratically, just possibly influenced by the first author’s role as consultant in a crisis resolution and home treatment team.

The authors highlighted the finding that functional teams were rated as reducing psychiatrists’ stress levels, applauding the positive effects of National Health Service (NHS) changes. Whereas consultants reported stress as a result of working across interfaces and from loss of continuity of care, Rathod et al write: ‘It is the authors’ opinion that it is the consequences of these changes… that are causing the stress rather than the changes per se’. So the changes are good, it is just their consequences that are bad? In fact, 21.4% of consultants in the study listed the creation of functional teams as stress reducing, whereas 49% and 44% respectively cited working across interfaces and loss of continuity of care as factors that caused stress.

New Ways of Working was introduced principally with the aim of reducing stress among psychiatrists. The possibility that the resultant loss of continuity of care, bemoaned both by patients ^{Reference Singhal, Garg, Rana and Naheed2} and by psychiatrists ^{Reference Dale and Milner3} for its negative clinical effects, may have actually increased psychiatrists’ stress levels does seem to be a most unfortunate outcome.

The counterbalance to stress in most areas of work is that of job satisfaction, a point that Rathod et al do not address. Especially at a time when recruitment into our specialty is falling, the point is an important one. For many practising psychiatrists, it is the continuity of responsibility for our case-loads of patients that provides job satisfaction and moderates stress.

If service changes have been associated with increased stress among psychiatrists and with reduced patient satisfaction, both against a backdrop of a crisis in recruiting doctors into psychiatry, is it perhaps time to think again?